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A Privilege of the Ordained M. Athanasius and the Church of Our Time Bp. Graber — read online. Ecclesiastical Winter Fr. Sometimes she gave high- pitched gasps, foamed at the mouth, vomited, urinated, or defecated.

Sometimes she had several seizures in a row; between them, she would tense, point her toes, and cry a strange deep cry. In the most serious episodes, Lia would continue seizing and seizing without regaining consciousness.

Inserting a needle into the vein of a baby who is having convulsions is like shooting, or trying to shoot, a very small moving target. Frightening as it was to be on duty when Lia was brought in at a.

The residents were merely the first line of defense. Every time Lia came to the emergency room, either Neil Ernst or Peggy Philp, the two supervising pediatricians who served on the faculty of the family practice residency program, was paged and, no matter how late it was, drove to the hospital a trip that could be accomplished, at just under the speed limit, in seven minutes. One leading to a grand mal seizure. I feel that probably the grand mal seizure caused an aspiration pneumonia and hence apnea, causing her extreme distress when she showed up in the Emergency Room on the day of admission.

The child has apparently done well on her Dilantin, although she has continued to have some right focal seizures…. My feeling is that this child probably has some form of benign focal seizures of infancy. These are not especially common, but can often be quite benign in nature. Since there is apparently some chance that these will generalize, it is probably worth while to keep the child on Dilantin therapy to suppress a grand mal seizure. I would check the Dilantin level to make sure that it remains therapeutic….

Neil and Peggy once went through a photocopy of it with me. The errors were invariably made by transcribers, nurses, or other physicians; their own contributions were flawless and usually even legible. He had forgotten that she had had epileptic seizures for five months before they were diagnosed and medicated, and was wondering in retrospect whether the course of her life might have been different if his hospital had offered her optimal medical care from the beginning.

Neil Ernst and Peggy Philp are married to each other. Neil and Peggy are both the children of physicians, both high school valedictorians, both Phi Beta Kappa graduates of Berkeley.

They met when they were nineteen and eighteen, two tall, good-looking, athletic premed students who recognized in each other the combination of idealism and workaholism that had simultaneously contributed to their successes and set them apart from most of their peers. Their schedules were arranged in such a way that one of them was always home in the afternoon when their two sons got out of school.

Every morning, the alarm buzzed at If it was Monday, Wednesday, or Friday, Neil got up and ran eight miles. If it was Tuesday, Thursday, or Sunday, Peggy got up and ran eight miles. They alternated Saturdays. Their runs were the only time either of them was entirely alone for more than a few minutes, and they never skipped or traded a morning, even if they had been up most of the night on call at MCMC. Peggy was on call at the hospital. We get along real well.

Real, real well. Medically, we complement each other. My strengths are infections, asthma, and allergies. Am I thinking okay? Would you offer anything else? Can I do anything else? If I feel like a dumbshit I can be a dumbshit with her. If she was not in my life it would…well, take a while for me to be able to function. They are perfect. Few other people I know would have gone to the lengths they did to provide good medical care to Lia.

They were always thinking about her. Her Physical Growth chart shows that although her height usually hovered around the fifth percentile for her age not unusual for a Hmong child , her weight climbed as high as the seventy- fifth percentile. Her thick subcutaneous padding compounded the challenges that awaited the doctors in the emergency room.

Considerable effort has gone into weight control in this child. The father apparently likes Lia the way she is and is somewhat resistant to this problem. A vein hidden under fat is hard to palpate. Like a drug user who loses veins after repeated needle sticks, Lia eventually lost the antecubital veins in both forearms and the saphenous vein above her left ankle after doctors frantically searching for needle placement cut them open and tied them off.

During most of her hospitalizations, the arm or leg with the IV line was bandaged to a board, and sometimes she was secured to her crib as well. Father here. Soft restraint to L arm. Returned child to bed, soft restraint to R arm. Tried to explain to father reason but difficult due to communication barrier. His confidence in their ability to care for Lia was further strained the morning after this note was written, when he left the hospital at a.

Foua and Nao Kao believed the best way to keep Lia safe and content, especially when she was ill or in pain, was to have her sleep next to them, as she always did at home, so they could immediately comfort her whenever she cried. You see them put a bag on your kid to measure the output of urine and stool. When your child is in the hospital, suddenly somebody else is feeding them, somebody else is changing their pants, somebody else is deciding how and when they will be bathed.

It takes all the autonomy of being a parent away, even for folks who have had a lot of medical experience. Mom here. Babe content. Cruises sides of crib. Makes baby sounds. Father trying to put her back to sleep. No seizures this shift. After she was old enough to walk, whenever she was well enough to get out of bed she ran up and down the corridor in the pediatric unit, banging on doors, barging into the rooms of other sick children, yanking open the drawers in the nursing station, snatching pencils and hospital forms and prescription pads and throwing them on the floor.

She was a little Houdini. With other Hmong families the sons are the ones who are loved. Hmong fathers say, Girl okay if die, want many boy. But this family, they wanted so much for her to live, they just adored her. When you asked for a hug you could always get one from Lia. So you kind of liked her because she was a character, even though you hated her because she was so frustrating and she caused you so much grief.

Lips pursed tightly to prevent this med given. Spits well. And even when Lia was co-operative, Foua and Nao Kao were often uncertain about exactly what they were supposed to give her. Over time, her drug regimen became so complicated and underwent so many revisions that keeping track of it would have been a monumental task even for a family that could read English.

For the Lees, it proved to be utterly confounding. The anticonvulsant medication originally prescribed by Peggy Philp was Dilantin, which is commonly used to control grand mal seizures. Three weeks after her first MCMC admission, after Lia had a seizure in the hospital waiting room that appeared to be triggered by a fever, Peggy changed the prescription to phenobarbital, which controls febrile seizures better than Dilantin. Lia seized several times during the next two weeks, so since neither drug appeared to work adequately alone, Peggy then prescribed them both simultaneously.

Consulting neurologists later prescribed two other anticonvulsants, Tegretol which was originally to be used along with both Dilantin and phenobarbital, and then just with phenobarbital and Depakene which was to be used in place of all the previous anticonvulsants. Because these medications were prescribed in varying combinations, varying amounts, and varying numbers of times a day, the prescriptions changed twenty-three times in less than four years.

Several of the medications were available in different forms, and were sometimes prescribed as elixirs all of which were pink or red and came in round bottles and sometimes as tablets almost all of which were white and came in round bottles. Foua and Nao Kao, of course, had no idea what the labels said.

Even if a relative or the hospital janitor was on hand to translate when a bottle was handed to the Lees, they had no way of writing down the instructions, since they are illiterate in Hmong as well as English; and because the prescriptions changed so frequently, they often forgot what the doctors told them. Measuring the correct doses posed additional problems.

Liquids were difficult because the Lees could not read the markings on medicine droppers or measuring spoons. Pills were often no easier. At one point, when Lia was two, she was supposed to be taking four different medications in tablet form twice a day, but because each of the pills contained an adult dose, her parents were supposed to cut each of the tablets into fractions; and because Lia disliked swallowing the pills, each of those fractions had to be pulverized with a spoon and mixed with food.

If she then ate less than a full helping of the adulterated food, there was no way to know how much medicine she had actually consumed. This was a dismaying realization. The only way to determine the optimal type and amount of anticonvulsant medications for Lia was to observe the level of her seizure activity and repeatedly test the medication level in her blood, but the test results were inconclusive unless the doctors knew exactly what was going into her system. Neither doctor could tell how much of their inability to get through was caused by what they perceived as defects of intelligence or moral character, and how much was caused by cultural barriers.

She was the first of a succession of public health nurses who were to visit the Lees over the next four years. Febrile seizures, noncompliant mother, noncompliant mother, noncompliant mother, noncompliant mother, noncompliant mother.

When Lia was taking elixirs, they tried drawing lines on the plastic syringes or medicine droppers to mark the correct doses. When she was taking pills, they tried posting charts on which they had drawn the appropriate pie-shaped fractions. They tried taping samples of each pill on calendars on which they had drawn suns and sunsets and moons. They tried putting the pills in plastic boxes with compartments for each day. There they would be, a little stack of bottles in the kitchen next to the tomatoes and onions, sort of like a decoration in the corner.

Because Lia was on such high doses, she had an appointment with Dr. Philp or Dr. Ernst almost every week and had a blood level drawn two or three days before and maybe another blood level two or three days afterwards, and there were so many changes that it was just totally mind-boggling.

My general impression was that they really felt we were all an intrusion and that if they could just do what they thought best for their child, that child would be fine. They were courteous and they were obstinate. They told us what we wanted to hear. Parents state infant is doing the same. Were unaware of appt.

Peds clinic for today. Were confused about proper dosage of medicine and which to give…. Several meds in refrigerator that are outdated included Amoxil and Ampicillin. Also one bottle of medication with illegible label. Ernst contacted concerning correct dosage of Phenobarb and Dilantin. Correct administration demonstrated.

Outdated medication discarded. Mother states she went to MCMC as scheduled for blood test, but without interpreter was unable to explain reason for being there and could not locate the lab.

Is willing to have another appt. States infant has not had any seizures. Have finished antibiotic. Are no longer giving Phenobarb because parents insist it causes diarrhea shortly after administration. Mother states she feels intimidated by MCMC complex but is willing to continue treatment there. Agree to have continued care at Peds clinic. Home visit made with interpreter. Mother has now decided to give mg. Phenobarb at night. Mother seems very agitated. Father out of house for rest of day—shopping.

Assured mother that child can be seen in Peds clinic Monday even without the Medi-Cal card. Home visit by interpreter to discuss childs care with father. Mother states they just returned from hospital that AM…. Diagnosis for hospitalization unknown to mother but antibiotic prescribed.

Their faith in medicines had not been strengthened by two routine immunizations Lia had received against diphtheria, pertussis, and tetanus, to which, like many children, she had reacted with a fever and temporary discomfort.

In some cases phenobarbital can cause hyperactivity—it may have been responsible for the riotous energy the nurses always noticed when Lia was hospitalized—and, in several recent studies, it has been associated with lowered I.

Dilantin can cause hair to grow abnormally all over the body, and gum tissue to bleed and puff out over the teeth. Too much phenobarbital, Dilantin, or Tegretol can cause unsteadiness or unconsciousness. Doctors are used to hearing patients say that drugs make them feel bad, and indeed the unpleasant side effects of many medications are one of the main reasons that patients so often stop taking them. Doctors who deal with the Hmong cannot take this attitude for granted.

John Aleman, a family physician in Merced, once hospitalized a Hmong infant with severe jaundice. After two or three samples, the parents said their baby might die if any more blood was removed. The doctor explained through an interpreter that the body is capable of manufacturing new blood, and he poured one cc of water into a teaspoon to demonstrate what an insignificant amount was being taken.

They said if the doctor drew any more blood against their will, they would both commit suicide. Fortunately, at this point Dr. The baby had the blood tests and was successfully treated with phototherapy. His parents, both teenagers who had attended American high schools and spoke and read English fairly well, consented, though reluctantly, to the surgical removal of the affected testis. She handed the parents a piece of paper on which she had typed the names of the drugs he would receive and their possible side effects.

Her predictions turned out to be accurate. Arnie, who had appeared perfectly healthy after his surgery, lost all his shiny black hair within three weeks after his first cycle of chemotherapy, and every time the drugs were administered, he vomited.

I say, Wait for my husband. I say, Please that you go away. I hold my son. I hold him so tight. I say, Give my son back. Two police, they hold my hand behind my back. I am scared. My two daughters are crying. The police hold my hand, they take my son away! I scream and cry. They were two long guns. We bought them to shoot squirrels and deer, not to shoot people. I just yell, Please bring my son back to me. I say, Just bring!

I want to hold my son! Finally some police officers brought Arnie back from the hospital, and when Dia Xiong saw him, she dropped the guns and was driven, in handcuffs, to the psychiatric unit of a local hospital. She was released the next day, and no criminal charges were filed against her.

Arnie is still in remission today. It is likely that the only Western drugs Foua and Nao Kao had encountered in Asia were fast-acting antibiotics. I felt they really cared for Lia, and they were doing the best, the absolute best they knew how as parents, to take care of the kid. That is what I felt about them. It was very foreign to me that they had the ability to stand firm in the face of expert opinion. And the other thing that was different between them and me was that they seemed to accept things that to me were major catastrophes as part of the normal flow of life.

For them, the crisis was the treatment, not the epilepsy. The parents report that they had discontinued the medications about 3 months ago because the patient was doing so well. At p. He therefore had to deal on his own with the most severe episode of status epilepticus Lia had yet suffered. He administered two more massive doses of phenobarbital. First Dan gave her mouth-to-mouth resuscitation, and when she failed to resume breathing on her own, he decided that a breathing tube had to be placed down her trachea.

This time I saw what I needed to see and the tube went right in and it worked perfectly and I felt really good. I thought, well, I guess I am becoming a doctor. I remember that they were very upset about that. I remember that the mother just had a very displeased look on her face.

She regained consciousness there, and was able to breathe on her own after twenty-four hours on a respirator. Lia spent nine days in Fresno, spiking high temperatures from aspiration pneumonia and gastroenteritis, but did not seize again. For four years, Jessica Stern interviewed extremist members of three religions around the world: Christians, Jews, and Muslims.

Traveling extensively—to refugee camps in Lebanon, to religious schools in Pakistan, to prisons in Amman, Asqelon, and Pensacola—she discovered that the Islamic jihadi in the mountains of Pakistan and the Christian fundamentalist bomber in Oklahoma have much in common.

Based on her One of the most powerful Islamic militant groups in Africa, Al-Shabaab exerts Taliban-like rule over millions in Somalia and poses a growing threat to stability in the Horn of Africa. Somalis risk retaliation or death if they oppose or fail to comply with Al-Shabaab-imposed restrictions on aspects of everyday life such as clothing, media, sports, interpersonal relations, and prayer.

Inside Al-Shabaab With terrorist groups expanding their weapons of destruction beyond bombs and bullets, chemical and biological warfare agents aren't merely limited to the battlefield anymore. In some cases, they are now being used on a new front: major metropolitan cities. Southern Afghanistan was slipping away.

That was clear to then-Captain Rusty Bradley as he began his third tour of duty there in The Taliban and their allies were infiltrating everywhere, poised to reclaim Kandahar Province, their strategically vital onetime capital. Dispatched as a diversionary



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